architects of architects of changechange Welcome to the ... · However, the disparity between Payer Data Sets and Provider Data sets presents a systemic, underlying challenge: ...

transforming healthcare through IT

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Welcome to the RHIO Revolution!EHRs , RHIOs, and the NHIN

Putting IT all Together

Jeff David, Director of Industry Development – HIMSS

March 24 2006: The Illinois EHR Task Force

What’s the Big Deal?• IOM - 44k – 98k people die yearly from medical errors • Study in JAMA found that missing information from 1,614

charts could, 44% of the time, adversely impact patient’s well-being

• RAND - patients receive appropriate care 55% of the time• Preventable healthcare-acquired infections cost $4.5B/yr

and contribute to over 88,000 deaths annually• CDC found that 16.7M elderly patient visits to physicians

result in prescription errors yearly

• All this while Healthcare is 15% of GDP and Growing!

Source: H.R. 2234 “21st Century Health Information Act of 2005”

Healthcare is Information• Over 90% of the activities that go into the delivery

of healthcare are centered around information and information exchange.

• The CONSUMER is the central object within this Information System.

• Therefore, clinically-derived “Consumer-Centric, Information-Rich” Electronic Health Recordswill become the common Nexus of Information for ALL players in the 21st century health system.

NHINNHIINationallevel

CHIN RHIOLHIIRegionlevel

CPR EMR EHRSitelevel

Time

Critical Care Units

Inpatient Med/Surg

Units

Hospital Outpatient

Departments

Large Group

Practices

Small Physician

Offices

Acute CareAmbulatory Care

1 Billion

8 Million

Volume of Encounters (Annual, U.S.)

Sources: Health Affairs W4-79, 2003; NAMCS Report, CDC, 2002

Revenue per Encounter$50

$50,000

$500

Payers

Purchasers

Consumers

Lab

Pharmacy

State of EHR Adoption

<1%Full EHR

43%Paper

56% Partial or

In Process90%Paper

<5%Full EHR

5% Partial

60%Paper

<15%Full EHR

25%Partial

Critical Care Units

Inpatient Med/Surg

Units

Hospital Outpatient

Departments

Large Group

Practices

Small Physician

Offices

Acute CareAmbulatory Care

Family Practice Physicians Rapidly Moving To EMRs

17%

13%

2%

7%

15%

16%

18%

7%

4%

0% 5% 10% 15% 20%

Complete EMR

Majority Of Info In EMR

Some EMR Use

Just Starting To Use

Buy W/I 12 Mos.

Buy W/I 24 Mos.

Buy>24 Mos.

No Plans

N/A

SOURCE: AAFP Survey 7/04

President Bush Gets IT“Medicine ought to be using modern

technologies in order to better share information, in order to reduce medical

errors, in order to reduce cost to our health care system by billions of dollars...Within

ten years, every American must have a personal electronic medical record. The

federal government has got to take the lead in order to make this happen by developing

what's called technical standards.”April 26, 2004

Secretary Leavitt Gets IT

• HHS - 60,000 personnel and a $½ Trillion budget• Visionary leader who is driven! • Industry Involvement• Funding• Katrina

July 2005: Establishes and personally chairs:AHIC

(American Health Information Community)

CMS…Mark McClellan gets IT

“How do we get the most benefits to the most people for a particular treatment?…Through widespread adoption of Modern HIT…through EMRs with direct links to Federal Agencies, through e-prescribing, through interoperability and standards, through robust data sharing between systems in order to collect Information regarding a Drug’s use in clinical practice and to monitor patient safety”

Mark McClellan, as FDA Commissioner in 2003, Harvard Business School Healthcare Alumni Conference, Nov. ‘03

Office of the National Coordinatorfor Health IT (ONCHIT)…

David Brailer, of course, gets ITDr. Brailer’s Priorities• Address Standards• Achieve Interoperability• Initiate Certification• Close Adoption Gap• Engage Incentives• Coordinate Federal Initiatives• Encourage Private Sector Leadership

ONCHIT and the Four GoalsGoal 1:

Inform Clinical Practice– Strategy 1: Incentivize EHR adoption

– Strategy 2: Reduce risk of EHR investment

– Strategy 3: Promote EHR diffusion in rural & underserved

ONCHIT and the Four GoalsGoal 2:

Interconnect CliniciansStrategies:

– Strategy 1: Foster Regional Collaborations (RHIOs).– Strategy 2: Develop a National Health Information

Network (NHIN) – Strategy 3: Coordinate Federal Health Information

Systems (CHI) The RHIO Revolution: Payers can either help to

do it or they will have it done to them

ONCHIT and the Four GoalsGoal 3:

Personalize CareStrategies:

– Strategy 1: Encourage Use of Personal Health Records (PHRs)

– Strategy 2: Enhance Informed Consumer Choice– Strategy 3: Promote use of Telehealth Systems

Is this not a Consumer-Driven Strategy?PHRs are to the CDHC Revolution as

EHRs are to the HIT Revolution

ONCHIT and the Four GoalsGoal 4:

Improve Population HealthStrategies:

– Strategy 1: Unify Public Health Surveillnace Architectures– Strategy 2: Streamline Quality and Health Status Monitoring– Strategy 3: Accelerate Research and Dissemination of Evidence.

-Improved surviellance = lower risk of catastrophic event-Healthier populations = lower costs-Evidence-Based Medicine = better outcomes

ONCHIT 4 RFPs and Contracts:• ONCHIT I: “Standards Harmonization” HITSP

(HIT Standards Panel) Harmonize industry-wide health IT standards’ development

• ONCHIT II: Certification CCHIT (The Certification Commission for HIT)

• ONCHIT III: NHIN Prototypes -- Create six prototypes of a national health information network (NHIN)

• ONCHIT IV: Privacy and Security -- Assess and develop plans to assess business policy and state laws that affect privacy and security practices

Out of the lab, into practice:Integrating the Healthcare

Enterprise

• A Proven, Real-world solution that creates frameworks for passing health information seamlessly from application to application, system to system, and setting to setting – all available in the public domain

• IT Infrastructure, Radiology, Cardiology, Lab, Care Summaries, Cross-Enterprise orders/results, Continuity of Care in both Ambulatory and Enterprise settings, ECG, Ophthalmology, patient care devices

Congress too!

– Frist-Clinton (S. 1262)– Murphy-Kennedy (H.R. 2234)– McHugh-Gonzalez (HR 747)– Stabenow-Snowe (S. 1227)– Grassley-Baucus (S. 1356) – Jeffords (S. 544)– HELP Legislation (S.1356)– 21st Century Health Caucus

Legislation• S. 1355 Better Healthcare through IT Act• S. 1262 Health Technology to Enhance Quality Act of 2005• S. 1227 The HIT Act of 2005• S. 1223 IT for Health Quality Act• S. 544 Patient Safety and Quality Improvement Act• S. 16 Affordable Health Care Act• S. 1356 Medicare Value Purchasing Act of 2005• S.1418 The Wired for Healthcare Quality Act • H.R. 2234 21st Century Health Information Act• H.R. 747 National Health Information Incentive Act of 2005

See Legislative Crosswalk at HIMSS.ORG

Frist / Clinton Joint Statement

“We have the most advanced medical system in the world, yet patient safety is compromised every day due to medical errors, duplication and other

inefficiencies. Harnessing the potential of information technology will help reduce errors and improve quality by making it more effective and

efficient.”Source: Senators Bill Frist (R-TN) and Hillary Rodham Clinton (D-NY) in a joint statement

on the growing consensus on health information technology, June 30, 2005

Newt Gingrich and Hillary Clinton Embrace!

New York Times -- A Good Idea From the Odd CouplePublished: May 16, 2005, Editorial

“The last thing that's likely to get noticed, amid all this potential for dish, is that the cause this odd couple was promoting in the press conference heard round the world is actually a very good one - the need to drag the health care industry out of the dark ages of scribbled notes and into the modern world of electronic record keeping…

...Shifting to electronic records that can be viewed by doctors, patients and health insurers not only will make the health care system more efficient, but also should reduce medical errors caused by sloppy records or the failure to communicate effectively.”

The States• Currently Tracking 150 HIT Bills Across the Nation in

State Legislatures– Wisconsin - $10M for HIT loans and grants– Connecticut – SB 6557 – Mandatory eRX and EMRs– Indiana – SB 566 – Establish Medical Informatics

Commission– Minnesota – HB 1162 – Establishes HIT Advisory

Committee– New Mexico – HB 780 – Electronic Health Data Study– ARIZONA: HB 2701 (Feb): Medical Error Reporting

• Governor’s are organizing state initiatives to support HIT adoption

The HIMSS RHIO FederationLaunched October 21, 2005

•Set realistic expectations for interoperable health information in the United States•Create and disseminate tools to foster successful exchange of health information•Conduct research that identifies best-of-breed, emerging themes and documents outcomes of RHIO execution•Connect the people who are tasked with executing RHIOs, as well as connecting the RHIOs themselves with payers, life sciences, vendors, consultants, policy-makers, and clinicians – everyone has a stake in the game

Current Interoperability Efforts

It’s About The Information, Not The TechnologyHowever, the disparity between Payer Data Sets and

Provider Data sets presents a systemic, underlying challenge:• Payers (employers, MCOs, governmen) rely upon claims data --

captures the units of care consumed and their costs, but little else (Medical Banking Too?)

• Providers rely upon clinical data -- helps determine why care was delivered and what were the results of that care

• These data sets are difficult to link, as a result, payers and providers “talk past each other”—payers look at costs, providers look at outcomes

“If a health improvement falls in the forest, and a payer can’t see it, did it really happen?”

C f Ki Sl A Z

Healthcare’s Data Disconnect:We know the Price of Everything

and the Value of Nothing

One clinical example of the Claims / Clinical data disconnect…

(Warning: the following slide containsgraphic imagery)

I’m sorry Mr. Jones, but your HMO does not pay for enemas. I’m going to have to have to

slap the sh*! outta you.

“I'm Not Bad,I'm Just Drawn that Way”

Jessica Rabbit, Who Framed Roger Rabbit, Disney 1988

TheCDHC

Revolution:Consumer-Driven Healthcare

The Health Plan (or Bank) as “Healthcare

INFOMEDIARY”

TheE.H.R.

Revolution“Delivering

Consumer-Centric, Information-Rich

Healthcare”

A Tale of Two Revolutions:

Evolution of Health Plans(courtesy of Ken Yale, DDS, JD)

Consumer AdvisorBenefit OptionsRisk ManagerWell/Care ManagementFinancial ServicesProvider EvaluatorData Driver

Administrative ServicesBenefit DesignRisk UnderwritingMedical ManagementClaims PaymentProvider NetworkingData Repository

Health Plan as “Infomediary”• Consumer choice• Financial services, risk management• Care coordination, collaboration• Provider monitor/evaluate/reward for quality• Health and disease management• Evaluate health and financial outcomes• Information management and transparency• Consumer experience management

(courtesy of Ken Yale DDS JD)

New Game / New Rules

• Can you survive as a next-generation healthcare infomediary using Claims-based Data Alone?

• Those players which are simultaneously able to participate in the clinically-based E.H.R. revolution will gain a competitive advantage.

• The worlds of Claims-based and Clinically-based information systems may be on separate tracks, but, like the transcontinental railway, those tracks can and should meet in the middle.

PHR vs EHR

• EHR: “An electronic version of the patient medical record kept by doctors and hospitals. The data in the EHR are controlled by and intended for use by medical providers.”

Source: Connecting for Health (Connecting Americans To Their Healthcare –Final Report, 7/04, chapter 2, p.13)

PHR vs EHR• PHR: “An electronic application through which

individuals can access, manage and share their health information in a secure and confidential environment. It allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it.”

Source: Connecting for Health (Connecting Americans To Their Healthcare – Final Report, 7/04, chapter 2, p.13)

A lesson from the 1939 World’s Fair:

The city of tomorrow will be designed and flourish under

the theme of…

“UNITYnot

UNIFORMITY”

Thank YouJeff David, MBA

Director of Industry DevelopmentHIMSS Payer and Life Sciences Initiative

jdavid @himss.org (734) 973-6116, ext.104